atezolizumab: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
atezolizumab: clinical details
Prescribing considerations
- Initiation and supervision require clinicians experienced in cancer treatment.
- Apply indication-specific pathology, molecular and PD-L1 selection criteria using validated testing where required.
- Review autoimmune disease, previous pneumonitis, brain metastases, chronic viral infection, HIV, significant cardiovascular disease, organ impairment and previous serious checkpoint-inhibitor toxicity.
- Immune-mediated reactions may involve multiple organs and occur after treatment cessation; investigate alternative causes and manage according to severity.
- For hepatocellular carcinoma treated with bevacizumab, assess and manage oesophageal varices and bleeding risk before combination treatment.
- Record the product name and batch number for traceability.
Contraindications and cautions
- Hypersensitivity to atezolizumab or any formulation excipient.
- The intravenous formulation must not be given subcutaneously, and the subcutaneous formulation must not be given intravenously.
Monitoring
- Assess for pulmonary, hepatic, gastrointestinal, endocrine, renal, neurological, muscular, cardiac, ocular, haematological and dermatological toxicity.
- Use clinical review and appropriate laboratory investigations, including liver, thyroid, glucose, renal and blood-count assessment as indicated.
- Monitor during administration for infusion- or injection-related reactions.
- Continue safety vigilance after treatment stops and ensure the patient carries the Patient Card.
Clinical pharmacology
Atezolizumab is an Fc-engineered humanised IgG1 monoclonal antibody that binds PD-L1, blocking its interaction with PD-1 and B7.1. It is cleared through protein catabolism, so conventional metabolic drug interactions are not expected.
Formulation and product differences
- The intravenous product is a concentrate requiring dilution before infusion and must not be administered as a push or bolus.
- The subcutaneous product is a ready-to-use solution containing recombinant human hyaluronidase to aid dispersion and absorption; it is administered into the thigh only.
- Injection-site reactions are an additional recognised adverse effect of the subcutaneous formulation.
- Patients may switch between formulations when clinically appropriate, but labels and administration routes must be checked carefully.
atezolizumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 840 mg, 1200 mg
Injection
Route: Parenteral
Strengths: 1875 mg
atezolizumab interactions
Formal pharmacokinetic interaction studies are limited, but immune-modifying treatments are clinically important.
Systemic corticosteroids
Routine systemic use before starting atezolizumab may interfere with its immune effect, although corticosteroids are used when clinically required to manage immune-related toxicity.
Other systemic immunosuppressants
Use before treatment should be reviewed because it may reduce atezolizumab's activity; specialist immunosuppression may still be required for toxicity.
Live attenuated vaccines
Tell the oncology team before vaccination because patients receiving recent live vaccines were excluded from clinical studies.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.